Spanish Journal of Agricultural Research

13(4), e05SC02, 6 pages (2015)
eISSN: 2171-9292
Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA)


Influence of subclinical endometritis on the reproductive
performance of dairy cows
Mónica Barrio1, Marcos Vigo2, Luis A. Quintela2, Juan J. Becerra2, Pedro J. García-Herradón2, Daniel Martínez-
Bello3, Francisco I. Fernandez-Sanchez1, Alberto Prieto2, Juan Cainzos2 and Ana I. Peña2
Xénese E.T.E. Barreiros, Sedes. 15596 Narón (A Coruña). Spain.  2 Universidade de Santiago de Compostela,
Facultad de Veterinaria de Lugo, Campus Universitario, Departamento de Patología Animal. 27002 Lugo. Spain.
Embriovet S.L. Rois 18 K. 15165 Bergondo (A Coruña). Spain

The aim of this study was to evaluate the influence of subclinical endometritis (SE) on the reproductive performance of dairy
cows. Ninety-four dairy cows of parity 1 to 8, distributed in 25 herds, were examined once between 30 and 45 days in milk using
transrectal palpation, vaginoscopy and ultrasonography. A cytological sample of the endometrium was taken only from cows with
an apparent healthy uterus (n=65). Serum glucose, total cholesterol, triglycerides, non-esterified fatty acids, β-hydroxybutyrate,
total proteins, albumin, urea and hepatic enzymes were analyzed. Reproductive indexes were recorded during the next 11 months.
Endometrial cytology was considered indicative of SE if percentage of polymorphonuclear neutrophils was superior to 5% of all
cells present in the smear, except erythrocytes. Results indicated that 14.9% of the cows sampled for uterine cytology had SE, and
that healthy cows become pregnant significantly before than those with SE (hazard ratio=2.35; 95% confidece interval: 1.05-5.3).
From all the metabolic and productive variables analyzed, only triglycerides affected negatively to reproduction; serum albumin
concentration, body condition score and milk production had positive effects on the reproductive performance. In conclusion, our
results indicate that SE has a negative impact on reproductive performance and uterine cytology is necessary to diagnose it since
almost 15% of the affected animals were not detected by other diagnosis methods.
Additional key words: subclinical endometritis; dairy cattle; ultrasound; endometrial cytology.
Abbreviations used: ALAT (alanine transaminase); ASAT (aspartate aminotransferase); BCS (body condition score); BHB
(beta-hydroxy butyrate); CI (confidence interval); HR (hazard ratio); NEB (negative energy balance); NEFA (non-esterified fatty
acid); PMN (polymorphonuclear neutrophil); S/C (services per conception); TAG (triglycerides); US (transrectal ultrasonography).
Citation: Barrio, M.; Vigo, M.; Quintela, L. A.; Becerra, J. J.; García-Herradón, P. J.; Martínez-Bello, D.; Fernandez-Sanchez, F. I.;
Prieto, A.; Cainzos, J.; Peña, A. I. (2015). Short communication: Influence of subclinical endometritis on the reproductive perfor-
mance of dairy cows. Spanish Journal of Agricultural Research, Volume 13, Issue 4, e05SC02, 6 pages.
Received: 05 Jun 2015. Accepted: 17 Nov 2015
Copyright © 2015 INIA. This is an open access article distributed under the terms of the Creative Commons Attribution-Non
Commercial (by-nc) Spain 3.0 Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Funding: Xunta de Galicia (Programa Sectorial de Medio Rural, Proyecto Ref. PGIDIT07MRU002E) and FEFRIGA, Santiago
de Compostela, Spain.
Competing interests: The authors have declared that no competing interests exist.
Correspondence should be addressed to Luis A. Quintela:

The postpartum period is considered of utmost phagocytosis of contaminating organisms by neutro-
importance in the reproductive life of the cow because phils. The presence of neutrophils in the uterine lumen
of its influence upon her future fertility (Oltenacu et is an excellent indicator of an active inflammatory
al., 1983). Uterine contamination at parturition or in process (Wade & Lewis, 1996). This is especially
the following days is considered normal, with 80- important in subclinical endometritis (SE) in which
100% of animals having bacteria in the uterine lumen physical examination of the reproductive tract may
in the first 2 weeks postpartum (Sheldon et al., 2006). not reveal evidence of inflammation (Mateus et al.,
The development of clinical disease is dependent on 2002). SE is characterized by inflammation of the
the balance between host immunity and bacteria endometrium that results in a significant impairment
pathogenicity (Grohn & Rajala-Schultz, 2000). The of the reproductive performance without signs of
primary defense mechanism of the bovine uterus is clinical endometritis (Sheldon et al., 2006). Among
2 Mónica Barrio et al.

the commonly used diagnostic tools, rectal palpation All animals calving between October 2008 and Feb-
is probably the most frequently used for diagnosis of ruary 2009 were evaluated for reproductive status be-
uterine infections, but it may be the most insensitive tween 30-45 days in milk (DIM) and, if presumed to be
and non-specific method (Gilbert & Schwark, 1992). in the luteal phase of the estrous cycle or anestrous,
Vaginoscopy is a straightforward procedure that per- were included in the study and a blood sample was
mits the evaluation of the characteristics of fluids in taken. Cows in estrus were not used. A total of 94 cows
the anterior vagina and external cervical os (Bretzlaff, were finally selected and examined by rectal palpation,
1987). Transrectal ultrasonography (US) has also been vaginoscopy and US. Cows with any detectable sign of
used to detect intrauterine fluid accumulation (Kasi- endometritis (abnormal discharge of uterine fluid, ab-
manickam et al., 2004; 2005) or cervical diameter normal fluid into the uterus or pathologic enlargement
(LeBlanc et al., 2002) and in spite that it offers the of the uterus) diagnosed by any of the three methods,
advantage of immediate diagnosis, its utility in SE were classified as having clinical endometritis and ex-
can be limited. The most precise procedure for diag- cluded from the study (n=29). Cows with no detectable
nosing endometritis was demonstrated to be cytobrush signs of endometritis were sampled for uterine cytol-
cytology (Barlund et al., 2008), which can help to ogy (n=65). Cows in their first month postpartum were
solve the negative impact of this uterine affection on not used because uterine involution might not have
the reproductive performance of dairy cattle. How- finished (Gautam et al., 2009) and then, a high percent-
ever, cytology is not frequently used in the daily age of polymorphonuclear neutrophil (PMN) in the
practice because the results are not immediate, and it uterine cytology would be a normal finding.
is more time-consuming than other diagnostic meth- Uterine cytology was obtained using a cytobrush
ods. (Quicklock 2000, Minitube Iberica, Barcelona, Spain)
Milk yield increases at a faster rate than energy intake twisted to the plunger of an insemination catheter
in the first 4 to 6 weeks after parturition, consequently (modified from Kasimanickam et al., 2004). The cyto-
high producing cows will experience some degree of brush was rolled onto a clean slide and allowed to air-
negative energy balance (NEB) and a negative balance dry. Slides were stained by Diff Quick (Quick Panop-
of other nutrients during early postpartum period. NEB tic®, Tarragona, Spain). All the slides were examined
has been positively correlated with serum concentrations by the same person using an optic microscope (CHT,
of triglycerids (TAG) and β-hydroxibutyric acid (BHB), Olympus, Barcelona) at 400X magnification. A mini-
and negatively associated with serum concentrations of mum of 150 cells (excluding erithrocytes) were count-
glucose and cholesterol in periparturient cows (Lean et ed on each slide to provide a quantitative assessment
al., 1992). Elevated liver TAG are associated with a of endometrial inflammation. Samples with ≥5% neu-
longer interval to first ovulation and with reduced fertil- trophils were categorized as SE positive (Gilbert et al.,
ity (Butler & Smith, 1989). It is well known that pro- 2005). Results of cytology were not reported to farmers
gesterone concentrations (Villa-Godoy et al., 1988), to prevent individual actions on the positive cows and
estrus behavior (Spicer et al., 1990) and days to first only investigators knew such information.
ovulation (Ducker et al., 1985) are all affected by the After genital examination, a blood sample was taken
degree of NEB in early lactation. by venipuncture of the coccygeal vein. Serum samples
The objective of our field trial was to determine the were separated by centrifugation and stored at -20ºC
prevalence of SE, diagnosed by uterine cytology, in a until analysis. Analyses were done with a digital pho-
group of dairy cows diagnosed as having a healthy tometer (Selecta MD200, Barcelona), except total
uterus by rectal palpation, vaginoscopy or US, and its proteins that were analyzed with a portable refractom-
impact on the postpartum fertility. Potential confound- eter (SELECTA, Barcelona). Glucose, total choles-
ers in reproductive performance such as metabolic terol, TAG and albumin concentrations were deter-
disorders or production level were considered in the mined by a colorimetric endpoint method by using
analysis. Biosystems® reagents (Biosystems, Barcelona); he-
For this study, Holstein cows (1-8 parities) from patic enzymes (Alanine transaminase [ALAT], Aspar-
25 farms located in the NW of Spain were used. The tate aminotransferase [ASAT]) were analyzed by the
average farm size was 35 animals, ranging from 15 to IFCC (International Federation of Clinical Chemistry)
90. Average annual milk production (305-day) was method (Tietz, 1991) using Biosystems® reagents; urea
8,610 kg. In 15 farms animals were housed in tied stall was assayed by a colorimetric enzymatic method using
barns and in the other 10 they were in free stall with Spinreact® reagents (Spinreact, Sant Esteve de Bas,
cubicles, and all used mixer wagon to prepare rations. Spain) and non-esterified fatty acids (NEFA) and BHB
Herds were maintained on monthly or biweekly repro- were analyzed by kinetic enzymatic kits (Randox
ductive control programs. Laboratoires, Antrim, UK).

Spanish Journal of Agricultural Research December 2015 • Volume 13 • Issue 4 • e05SC02
Short communication: Influence of subclinical endometritis on the reproductive performance 3

Animal specific data (body condition score [BCS], Only TAG and albumin had significant effects on
parity, parturition date), periparturient disorders (as- the interval calving to conception according to the Cox
sisted calving, retained fetal membranes, abortion, model. Increased levels of albumin or reduced levels
hypocalcaemia, ketosis, mastitis, etc.) were recorded. of TAG were associated to shorter calving to concep-
Starting from the day of the reproductive exam, in- tion intervals (Table 2). Moreover, increase of milk
semination dates, pregnancy diagnosis dates and milk production was associated with a shorter calving to
production were obtained from the herd reproductive conception interval. No other metabolic variables had
management software, during 11 months following relationship with the interval calving to conception.
samples collection. Calving to first insemination interval and number of
A Kaplan-Meier survival analysis was used to com- S/C were not significantly different in healthy animals
pare calving to conception and to first insemination vs. those with SE. Only TAG levels had an effect on
intervals and services per conception (S/C), both in the number of S/C and BCS had an effect on calving
animals with or without SE. Survival analysis was used to first insemination interval (Table 2).
to examine the number of S/C considering each service In the present study, the prevalence of SE (14.9%)
as a “time period” (Gilbert et al., 2005). found between 30 and 45 DIM was lower than that
Parity, production in 305-day, body condition, bio- reported by other studies [34%, Kasimanickmam et al.
chemical profile (glucose, NEFA, BHB, total choles- (2004); 53%, Gilbert et al. (2005)] and higher than that
terol, TAG, total proteins, albumin, urea, ASAT, ALAT) reported by Lopdell et al. in 2011 (7%). Such discrep-
and cytology results were included in a Cox´s propor- ancies can be due to the different DIM periods chosen
tional hazards regression model for calving to concep- for the diagnosis, different cut offs for PMN%, or to
tion and calving to first insemination intervals and for different management systems of the farms studied.
S/C. All the independent variables were confirmed to One of the reasons for the low SE prevalence found in
comply the proportional hazards assumption. Models this study was the criterion used for the diagnosis, as
were built by reverse stepwise elimination using a cow was considered with SE when the condition was
likelihood-ratio test statistics, with threshold p values diagnosed exclusively by endometrial cytology. In ad-
<0.1 for inclusion and >0.15 for exclusion. dition, any amount of echogenic fluid in the uterus was
The Kaplan-Meier estimated median times from considered a sign of clinical endometritis (Barlund et
calving to conception, calving to first insemination and al., 2008). Therefore, we classified as clinical endome-
S/C are shown in Table 1. Cows with negative endo- tritis some cases that other researches would have
metrial cytology became pregnant earlier (HR=2.35; considered to be subclinical (Kasimanickman et al.,
95% CI: 1.05-5.29) than those with SE (Fig. 1). 2004). The PMN cut off used for establishing the limit

Table 1.  Results [median (confidence interval)] of Kaplan-Meier analyses for calving to conception and calving to first insemi-
nation intervals and services per conception

Calving to conception Calving to first
n Services per conception
interval insemination interval
Subclinical endometritis 14 154 (82.50-225.50) 77 (64.17-89.83) 3 (1.90-4.11)
No endometritis 51 119 (88.14-149.86) 68 (61.91-74.10) 2 (1.10-2.90)
p value 65 0.09 0.11 0.19

Table 2. Factors affecting reproductive variables obtained with Cox regression analyses

Dependent variable Variables in the equation1 p-value HR2 95% CI of HR2
Calving to conception interval Production*100 (305-d) 0.05 0.98 0.96-1.00
TAG (mg/dL) 0.01 0.92 0.87-0.98
Albumin (g/L) 0.05 1.05 1.00-1.10
PMN < 5% 0.04 2.35 1.05-5.29
Calving to first insemination interval BCS 0.008 2.62 1.29-5.34
Services per conception TAG (mg/dL) 0.02 0.94 0.88-0.99
TAG, triglycerides; PMN, polymorphonuclear neutrophil; BCS, body condition score; 2 HR, hazard ratio; CI, confidence interval.

Spanish Journal of Agricultural Research December 2015 • Volume 13 • Issue 4 • e05SC02
4 Mónica Barrio et al.

between healthy animals and those with SE was slight- significantly different for the two groups of animals
ly inferior than that used by other authors (Kasiman- (68 d for healthy cows vs 77 d for cows with SE). Al-
ickam et al., 2004; Sheldon et al., 2008), thus, this though the two individual variables (longer interval
factor was not likely to be responsible for the lower calving first service and higher number of S/C) had no
prevalence found in this trial. Neither have we attrib- significant effects, both together contributed to the
uted the difference to the cytology technique, since significantly longer interval calving to pregnancy found
cytobrush is believed to be more sensitive than uterine in this trial in cows with SE.
washing for detecting SE (Kasimanickam et al., 2005). Reproductive problems may be associated to imbal-
Studies in dairy cows have shown an increase in ances of the animals’ metabolic status. With the purpose
days open and a diminished likelihood of pregnancy of isolating the effect of SE, several metabolic variables
before 300 d postpartum for cows cytologically diag- were included in the Cox model so to assess their po-
nosed with endometritis after 40 or 50 d postpartum tential influence on reproduction. The need to analyze
(Gilbert et al., 2005). Likewise, the present results metabolic parameters arose because several farms did
showed an effect of SE on the interval from calving to not have good records of metabolic diseases occur-
conception: 80% of healthy cows were pregnant with- rence, or not always were diagnosed, as for example
in 200 days postpartum whereas only 60% of cows with subclinical ketosis. Only TAG, albumin, BCS and milk
SE did (Fig. 1). production had significant effects on reproduction. We
The role of PMN in inflammatory processes is the found that TAG affected negatively to the interval calv-
rapid inactivation and elimination of foreign and altered ing to conception, and BCS affected negatively to the
autologous structures. In addition, they exert various interval calving to first insemination. TAG accumulate
regulatory functions such as release of cytokines, prim- in liver after body fat mobilization and they are con-
ing, activation or inhibition of cells, or influencing the sidered good indicators of NEB (Rukkwamsuk et al.,
expression of surface molecules (Baggiolini et al., 1999). Other authors related high levels of TAG in liver
1993). Certain cytokines can decrease luteinizing hor- (Butler & Smith, 1989) and NEB (Beam & Butler,
mone release (McCann et al., 2000) causing a delay in 1999) with a long interval between calving and first
the onset of postpartum cyclic activity and increasing ovulation, and with low fertility. Levels of BHB (Kes-
the interval calving to first insemination. In the present sel et al., 2008), NEFA (Bronicki et al., 1996) and urea
study, the interval calving to first insemination was not (Moreira da Silva et al., 1997) have been associated to
adverse reproductive parameters, but such effects were
not seen in this study. Nevertheless, the small number
of cows diagnosed with SE in this study may have
1.0 masked the influence of these variables on reproduc-
tion. On the other hand, metabolic parameters were
analyzed during the second month postpartum, and
perhaps this is not the best moment to determine their
effect on reproduction, as the NEB is known to be more
severe during the first 30 d (Cavestany et al., 2005).
Cumulative proportion survive

By contrast, albumin had a positive effect on reproduc-
tive efficiency, probably linked to the correct function
of liver, since albumin was found to be good indicator
of a healthy liver (Lubojacká et al., 2005).
0.4 Definitive conclusions could not be drawn from this
study as the number of cows diagnosed with subclini-
cal endometritis between 30 and 45 days in milk was
0.2 low (14) and therefore, the real impact of the meta-
bolic status of the cows on reproduction could not be
accurately determined. Nevertheless, a negative effect
0.0 of subclinical endometritis on reproductive perfor-
0 100 200 300 400
mance was observed. Endometrial cytology can be used
Time to conception (days) as a rapid and easy method to diagnose subclinical
endometritis and should be recommended to practition-
Healthy Subclinical endometritis ers as a number of animals suffering subclinical endo-
Figure 1.  Calving to conception interval based on the presence metritis cannot be diagnosed by rectal exploration,
or absence of subclinical endometritis. transrectal ultrasonography or vaginoscopy.

Spanish Journal of Agricultural Research December 2015 • Volume 13 • Issue 4 • e05SC02
Short communication: Influence of subclinical endometritis on the reproductive performance 5

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